l'oints of unusual interest: 1. Two years since the first symptoms appeared; the patient has, during the greater part of the time, been able to be about on her feet, doing light work. 2. Almost entire absence of the usual pressure symptoms. 3. Remarkable result of the therapeutic measures: iodide of potas sium, mercurial inunctions, and repeated venesection. 4. Decided benefit gained from venesection. On one occasion, at least, the patient's life was undoubtedly saved by the prompt opening of a vein and the withdrawal of twenty-eight ounces of blood. J. B. Shober (Amer. Jour. Med. Sciences, Feb., '97).
Remarkable case of aneurism of one of the sinuses of Valsalva met with in a man, aged about 45, found dead. The aneurism bulged into the right auricle and ruptured at a point just above the attachment of the posterior tricuspid segment.
In 1840 Thurman collected 22 eases where aneurism of the aortic sinuses was present. Twenty further cases given. Cottell and Steele (Inter. Med. Mag., pp. 253-263, '97).
The situation of the aneurism with reference to the superior vena cava and subclavian vein causes various accidents. The aneurism may burst into the supe rior vena cava, or may compress it, caus ing engorgement of the vessels of the head and arm; or it may compress the subclavian vein, when the right arm is enlarged.
Aneurism of the ascending portion of the aortic arch that lead to external rupture. External rupture is one of the more uncommon terminations of a tho racic aneurism. According to Crisp's tables, this occurred six times in one hundred and thirty-six cases of aneu rism of the ascending arch which he found recorded. Stewart and Adami (Montreal Med. Jour., Nov., '96).
Case of large aneurism of the arch of the aorta was treated by Macewen's method. The tumor occupied third right intercostal space and was six and one half centimetres across at its base. At five different times two needles were inserted, and at two other times one needle. The needles were removed one or two days later. The treatment re quired about two months. No swelling could then be perceived at the level of the tumor. It was almost as hard as bone; percussion gave dullness over the manubrium of the sternum and extend ing somewhat to its right. A. Gignane (Gaz. degli Osp. e d. Clinic., No. 62, '96).
These aneurisms may affect the right recurrent laryngeal nerve; and also press the inferior vena cava, which is lowed by ascites and oedema of the feet.
Point in aortic aneurism emphasized of recent years: the comparatively fre quent latency of aortic aneurism, the disease then giving rise to very few or indefinite symptoms. A paralysis of the left vocal cord may constitute the first means of recognizing the aneurism. Auscultation of the upper part of the left interscapular space may reveal an arterio-diastolic murmur not heard else where, or there may be here, or in the neighborhood, a systolic murmur due to the beating of aneurismal sac on the left bronchus. Gerhardt (Deutsche med. Woch., June 10, '97).
The heart may be pushed down to the left.
Rupture into the pleura or superior vena cava is the usual cause of death, but this may be due to heart-failure or to external rupture.
Transverse Arch.—Three varieties of aneurism are observed in this location. In the first and most common form the aneurism is small and not visible exter nally. The growth is directed backward or downward and may involve the oesoph agus, causing dysphagia. The trachea may also be pressed upon, giving rise to cough, which is often paroxysmal. The left recurrent laryngeal nerve may also be compressed as it passes around the arch of the aorta or a bronchus. In the latter case bronchiectasis, bronchorrhcea, and suppuration into the lung, not commonly the cause of death, may result.
The second variety of aneurism of this class is that in which the mass may ject forward and simulate a large tumor.
It may destroy the sternum and pene trate the opening thus created.
In the third class the aneurism may grow on both sides into the pleura be tween the sternum and vertebral column. This form may last for years. The ca rotid (radial pulse) may be affected by the involvement by the sac of the innom inate artery, or more rarely the carotid and subclavian arteries.
Compression of the thoracic duct, an occasional complication, may finally in duce inanition. When the compression includes the sympathetic nerve, there is, at first, dilatation of the pupil; this may be followed by paralysis, with contrac tion of the pupil. Pressure of the ver tebrae may cause severe pain; of the (esophagus, dysphagia; of the lungs or bronchi, bronchiectasis, the retention of pulmonary secretions giving rise to fever.